Critical care nursing quarterly
-
Tight glucose control can significantly improve outcomes of critically ill geriatric patients in the critical care unit (CCU). In the past, blood glucose levels were managed by a point-of-care testing every 4 to 6 hours and using a sliding scale of insulin therapy. ⋯ Studies have shown that patient outcomes improve by having a specific set of standing orders, a well-defined algorithm, and empowering the CCU nurses with these tools. Methods for initiating intensive intravenous insulin therapies are discussed along with some of the biggest challenges faced by CCU nurses at the bedside.
-
In the United States, 4.9 million people aged 65 years and older have Alzheimer's disease (AD). Medicare costs for patients with heart disease, diabetes, congestive heart failure, or chronic obstructive pulmonary disease and dementia are higher than for those without dementia. Although one principle of care for persons with AD is "do not hospitalize," comorbidities may require inpatient care. This article presents a definition, the diagnostic criteria for AD, and information about differential diagnosis, risk factors, pathology, progression, evidence base for practice, assessment, pharmacologic management, guidelines for general inpatient care, discharge planning, and interventions related to communications, environment, spirituality, special tasks (eating, protecting tubes and dressings, bathing), stages of AD, and special problems (wandering, pain, incontinence, hallucinations, aggression).
-
The introduction of family presence evidence-based practice into a baccalaureate nursing curriculum.
The topic of family presence (FP) during cardiopulmonary resuscitation or invasive procedures has recently received attention and debate among healthcare professionals due to pioneering research in this field. Studies completed have included family perspectives on family presence, patients' feelings on family presence, and healthcare providers' views on family presence. ⋯ Senior nursing students in one baccalaureate program were introduced to this topic during a 3-hour class on death and dying. Comparisons between pretest and posttest scores revealed an increase in the acceptance of family presence as a priority in nursing care of the critically ill.
-
Despite enormous advances in the medical management of heart disease, heart failure (HF) persists as a leading cause of hospitalization in our elderly. In 2001, the American Heart Association and the American College of Cardiology published Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease. The guidelines proactively responded to a growing body of evidence confirming that comprehensive risk factor management and risk reduction improve quality of life and survival, while reducing recurrent cardiovascular events. ⋯ The implementation and monitoring of Core HF Measures has prioritized attention toward patient education and risk factor modification to prevent future hospitalization. Critical care nurses are on the frontline to champion uptake and adherence of Core HF Measures. The purpose of this article is to highlight the critical component that nursing care, guided by the Core HF Measures, can offer to improve the quality of patient care in acute decompensated heart failure.
-
Review
Proactive monitoring: implications of implantable devices for future heart failure management.
Heart failure (HF) decompensation continues to account for approximately 1 million hospitalizations per year in the United States. Pulmonary congestion is the hallmark sign of worsening HF. Better strategies aimed at identifying subclinical congestion would be of great value in the management of HF. ⋯ These implantable monitors can provide valuable information of ongoing fluid status. Data retrieval can be useful for monitoring effectiveness of treatment and patient teaching, thereby resulting in an individualized treatment regimen based on real-time data. Proactive monitoring of HF patients may prevent future HF decompensation.